Provider Demographics
NPI:1760609259
Name:JOSHUA M. MASINO, PSY.D., LLC
Entity Type:Organization
Organization Name:JOSHUA M. MASINO, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MYLES
Authorized Official - Last Name:MASINO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-242-8188
Mailing Address - Street 1:1071 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1843
Mailing Address - Country:US
Mailing Address - Phone:404-242-8188
Mailing Address - Fax:378-393-8637
Practice Address - Street 1:1071 CAMBRIDGE SQ
Practice Address - Street 2:SUITE E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1843
Practice Address - Country:US
Practice Address - Phone:404-242-8188
Practice Address - Fax:378-393-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003043103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherHUMANA
GA68BBGTDMedicare ID - Type Unspecified